title: National cost of trauma care by payer status.
abstract: BACKGROUND
  Several studies have described the burden of trauma care, but few have explored the economic burden of trauma inpatient costs from a payer's perspective or highlighted the differences in the average costs per person by payer status. The present study provides a conservative inpatient national trauma cost estimate and describes the variation in average inpatient trauma cost by payer status.
  
  
  METHODS
  A retrospective analysis of patients who had received trauma care at hospitals in the Nationwide Inpatient Sample from 2005-2010 was conducted. Our sample patients were selected using the appropriate "International Classification of Diseases, Ninth Revision, Clinical Modification" codes to identify admissions due to traumatic injury. The data were weighted to provide national population estimates, and all cost and charges were converted to 2010 US dollar equivalents. Generalized linear models were used to describe the costs by payer status, adjusting for patient characteristics, such as age, gender, and race, and hospital characteristics, such as location, teaching status, and patient case mix.
  
  
  RESULTS
  A total of 2,542,551 patients were eligible for the present study, with the payer status as follows: 672,960 patients (26.47%) with private insurance, 1,244,817 (48.96%) with Medicare, 262,256 (10.31%) with Medicaid, 195,056 (7.67%) with self-pay, 18,506 (0.73%) with no charge, and 150,956 (5.94%) with other types of insurance. The estimated yearly trauma inpatient cost burden was highest for Medicare at $17,551,393,082 (46.79%), followed by private insurance ($10,772,025,421 [28.72%]), Medicaid ($3,711,686,012 [9.89%], self-pay ($2,831,438,460 [7.55%]), and other payer types ($2,370,187,494 [6.32%]. The estimated yearly trauma inpatient cost burden was $274,598,190 (0.73%) for patients who were not charged for their inpatient trauma treatment. Our adjusted national inpatient trauma yearly costs were estimated at $37,511,328,659 US dollars. Privately insured patients had a significantly higher mean cost per person than did the Medicare, Medicaid, self-pay, or no charge patients.
  
  
  CONCLUSIONS
  The results of the present study have demonstrated that the distribution of trauma burden across payers is significantly different from that of the overall healthcare system and suggest that although the burden of trauma is high, the burden of self-pay or nonreimbursed inpatient services is actually lower than that of overall medical care.
authors.affiliation: Department of Surgery, Center for Surgical Trials and Outcomes Research, Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA.
authors.forename: Catherine G
authors.initials: CG
authors.lastname: Velopulos
authors.forename: Ngozi Y
authors.initials: NY
authors.lastname: Enwerem
authors.forename: Augustine
authors.initials: A
authors.lastname: Obirieze
authors.forename: Xuan
authors.initials: X
authors.lastname: Hui
authors.forename: Zain G
authors.initials: ZG
authors.lastname: Hashmi
authors.forename: Valerie K
authors.initials: VK
authors.lastname: Scott
authors.forename: Edward E
authors.initials: EE
authors.lastname: Cornwell
authors.forename: Eric B
authors.initials: EB
authors.lastname: Schneider
authors.forename: Adil H
authors.initials: AH
authors.lastname: Haider
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000191:economics*; D038801:International Classification of Diseases / Q000191:economics; D007902:Length of Stay / Q000191:economics; D008484:Medicaid / Q000191:economics*; D006278:Medicare / Q000191:economics*; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000191:economics* / Q000453:epidemiology; D014950:Wounds, Penetrating / Q000191:economics* / Q000453:epidemiology; D055815:Young Adult
keywords: Cost of trauma care; Cost shifting by payer; National trauma cost